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Herpes simplex encephalitis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesHerpes simplex encephalitisSCE Acute Medicine

A 67-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show temporal lobe MRI change, seizures and lymphocytic CSF. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Start intravenous aciclovir immediately

The key discriminator is that temporal lobe MRI change, seizures and lymphocytic CSF, which makes Start intravenous aciclovir immediately the single best answer. Arrange routine outpatient follow-up is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://bnf.nice.org.uk/#acute-medicine-order-28-1